They say HPV blood test should supplant Pap smear in some cases, while task force says merits of newer test still unclear.

Related

WEDNESDAY, Oct. 19 (HealthDay News) —
Three leading U.S. cancer groups have proposed new guidelines for cervical
cancer testing for women, including when to start screening for
sexually active young women, extending intervals between screenings and in some
cases, supplementing the traditional
Pap test with human papilloma virus (HPV)
testing.

The American Cancer Society, the American Society for Colposcopy
and Cervical Pathology and the American Society for Clinical Pathology joined
to create the guidelines, which advise women to get fewer
screenings over their lifetime and that women 65 and older with a
history of normal Pap tests can stop altogether.

The guidelines also call for combination HPV-Pap testing in women
aged 30 and older, placing stronger emphasis on HPV testing than another set of
guidelines officially released at the same time, from an independent and
influential government panel.

That government panel, the U.S. Preventive Services Task Force
(USPSTF), is reaffirming the Pap test as the best way for women aged 21 to 65
to spot cervical cancer, saying it "substantially" cut the number of
deaths from the disease.

The USPSTF remains cautious on the use of the human papillomavirus
(HPV) blood test to detect cervical cancer. It moved against the use of the HPV
test in women under the age of 30, and said that evidence was still lacking on
its risks vs. benefits to recommend it in women aged 30 and older.

The three cancer groups said they coordinated Wednesday's release
with the USPSTF to "enable stakeholders to consider both sets of
recommendations concurrently with the goal of creating consistent guidance that
will lead to less confusion for providers and the public."

The USPSTF looks over the latest evidence-based research to come to
its recommendations, which are closely watched by physicians and insurance
companies. The panel's decisions are often controversial: in 2009, it
recommended against annual mammograms for women in their 40s, and just last
week it said the risks of the prostate-specific antigen (PSA) blood test
outweigh its benefits in detecting prostate cancer.

The results of two evidence reviews by the USPSTF on cervical
cancer screening conducted by the panel were published Oct. 18 in the Annals
of Internal Medicine.

"Cervical cancer screening is a public health success
story," said study author Dr. Evelyn P. Whitlock, a preventive medicine
specialist at Kaiser Permanente Center for Health Research in Portland, Ore.
"The number of women dying from cervical cancer has been cut in half due
to regular screening."

But "there are still about 12,000 women diagnosed with
cervical cancer every year and 4,000 women die from cervical cancer each
year," she said. "We need to continue to improve so we have a fully
successful screening program. We are trying to improve on success and that is a
pretty high bar."

To compare the Pap against the HPV test, the researchers analyzed
four studies they deemed of fair-to-good quality, encompassing nearly 142,000
women.

HPV causes many cases of cervical cancer, and incorporating HPV
testing into cervical cancer screening programs may catch more at-risk women.
However, the researchers found that HPV testing, on its own, yields too many
false positives which results in unnecessary testing, anxiety and health care
costs for many women.

According to the new report, HPV testing is more sensitive, but
less specific than the Pap test, Whitlock said. "This means that more
women who have nothing wrong with them will test positive with HPV testing, and
this may cause potential harm," she said.

During a Pap test, a doctor scrapes cells from a woman's cervix and
a laboratory examines these cells for abnormalities. When a type of Pap test
called a liquid-based cytology test is performed, testing for HPV can be
performed at the same time.

Dr. Elizabeth A. Poynor, a gynecologic oncologist and pelvic
surgeon at Lenox Hill Hospital in New York City, said this is a work in
progress. "We are still learning how to incorporate HPV testing into our
current algorithm," she said. "Women need to ask their physician
which screening strategy is best for them based on their personal risk
factors."

Another review article looked at the appropriate ages to initiate
and discontinue cervical cancer screening. The authors conclude that screening
for cervical cancer should continue to begin at age 21. If a woman age 65 or
older has had an adequate number of normal Pap test results and is not
considered high risk for cervical cancer, she can stop screening at age 65.
Older woman who are considered at high risk for cervical cancer include those
who have had previous high-grade cervical lesions or a history of cervical
cancer.

Dr. Mark Wakabayashi, chief of gynecologic oncology at the City of
Hope Cancer Center in Duarte, Calif., said that the real issue is that some
women never get either test. "The ones who don't get Pap tests are the
ones who are dying from cervical cancer," he said. "We are trying to
be more cost-effective with our screening for cervical cancer, but we don't
want to mess with success."

This site complies with the HONcode standard for trustworthy health information: verify here.

Advertising Notice

This Site and third parties who place advertisements on this Site may collect and use information about
your visits to this Site and other websites in order to provide advertisements about goods and services of
interest to you. If you would like to obtain more information about these advertising practices and to make
choices about online behavioral advertising, please click here.